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Traveling to a High-volume Center is Associated With Improved Survival for Patients With Esophageal Cancer

Speicher, Paul J. MD; Englum, Brian R. MD; Ganapathi, Asvin M. MD; Wang, Xiaofei PhD; Hartwig, Matthew G. MD; D’Amico, Thomas A. MD; Berry, Mark F. MD

doi: 10.1097/SLA.0000000000001702

Background: An association between volume and outcomes has been observed for esophagectomy, though little is known about why or how patients choose low- or high-volume centers. The purpose of this study was to evaluate how travel burden and hospital volume influence treatment and outcomes of patients with locally advanced esophageal cancer.

Methods: Predictors of receiving esophagectomy for patients with T1-3N1M0 mid or distal esophageal cancer in the National Cancer Data Base from 2006 to 2011 were identified using multivariable logistic regression. Survival was compared using propensity score-matched groups: patients in the bottom quartile of travel distance who underwent treatment at low-volume facilities (Local) and patients in the top quartile of travel distance who underwent treatment at high-volume facilities (Travel).

Results: Of 4979 patients who met inclusion criteria, we identified 867 Local patients who traveled 2.7 [interquartile range (IQR): 1.6–4 miles] miles to centers that treated 2.6 (IQR: 1.9–3.3) esophageal cancers per year, and 317 Travel patients who traveled 107.1 (IQR: 65–247) miles to centers treating 31.9 (IQR: 30.9–38.5) cases. Travel patients were more likely to undergo esophagectomy (67.8% vs 42.9%, P < 0.001) and had significantly better 5-year survival (39.8% vs 20.6%, P < 0.001) than Local patients.

Conclusions: Patients who travel longer distances to high-volume centers have significantly different treatment and better outcomes than patients who stay close to home at low-volume centers. Strategies that support patient travel for treatment at high-volume centers may improve esophageal cancer outcomes.

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*Department of Surgery, Duke University Medical Center, Durham, NC

Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC

Department of Cardiothoracic Surgery, Stanford University Medical Center, Palo Alto, CA.

Reprints: Mark F. Berry, MD, 300 Pasteur Drive, Falk Cardiovascular Research Institute, Stanford, CA 94305. E-mail:

Disclosures: Institutional funding was the primary funding source for this study. In addition, this work was supported by the NIH-funded Cardiothoracic Surgery Trials Network (M.F.B. and M.G.H.), 5U01HL088953-05. One of the authors (T.A.D.) serves as a consultant for Scanlan International, Inc. The other authors have no conflicts of interest to declare.

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